1. Emergency laparoscopic stoma for obstructing colorectal cancer
Abdulrahman A. Almuhrij, MD, MBBS, Khaled Saber, MD, FRCS, Alhassan Alnaamy, MD, FRCS , Amro Salem, MD, MSc, FRCS.

2. Hypothesis
Is laparoscopic stoma a valuable alternative in term of morbidity when compared to patients underwent colonic stent insertion for obstructing primary colon cancer as a bridge to surgery or as a palliative treatment?

3. Background
-Management of obstructing left colonic bowel cancer remains challenging. -At present there are not enough studies that demonstrate which is better to our knowledge, laparoscopic stoma creation or self- expandable stent insertion as palliative or as a bridge to surgery.

4. Single Stage Resection “On table” irrigation and segmental resection
Colonic obstruction
Up to 30% of colon cancer
Hartmann’s procedure
Colostomy closure
Colostomy – 40%
Complications of colostomy 34%
*Possibility up to 60%*
Depends on:
Patient clinical condition
Team’s experience
Intraoperative findings
Single Stage Resection
“On table” irrigation and segmental resection
Subtotal colectomy

5. Aim
Is laparoscopic stoma a valuable alternative compared to colonic stent for obstructing left colonic cancer, as a bridge to surgery or as a palliative treatment ?

6. Methods -January 2012 and December 2012
-retrospective
-January 2012 and December 2012
-Including criteria: patients with obstructed primary colorectal cancer.
-Exclusion criteria: missing data, patients lost follow up
-follow up 6 months.

7. Methods
-Selection of patients for stenting or surgery was dependent on surgeon preference, endo- scopist skills and patient fitness for surgery. -Criteria for palliative versus bridge to surgery colonic stenting were based on colonoscopy, computer tomography (CT), magnetic resonance imaging and positron emission tomography scans.

8. Methods
-31 patients. Six cases were not included due to missing data. -60% (n=15) of the patients underwent SEMS insertions -40% (n=10) underwent laparoscopic stoma creation

9. Methods
-After successful stenting, all patients underwent a full oncology assessment, cardiac workup if needed and anesthetic workup in the same admission after the decompression.
-All stents were inserted via a colonoscope under radiological guidance using an image intensifier.

10. Methods
-Colonic stent insertion was successful when patient passes stool and flatus in the first day post stenting or within 3 days post laparoscopic surgical decompression using stoma.
-Some patients were operated with surgical resection in the same admission.

11. Results
-80% (n=20) male. -Age years (mean age 47.23). -tumor site were 48% (n=12) in the rectum, 28% (n=7) were on the recto-sigmoid junction, 12% (n=3) in the sigmoid, 8% (n=2) in left colon and 4% (n=1) in hepatic flexure.

12. Results
-44% (n=11) were as a bridge neoadjevent chemo/chemoradiation therapy then to surgery
-52% (n=13) for palliative care
-Early technical success was achieved in all SEMS insertion.
-20% (n=2) patients didn’t achieve the early success in laparoscopic stent.

13. Laparoscopic stoma creation group
Results - morbidities
Stent group
stent migration
19.8% (n=3)
tumor growth and engulfing of the stent
6.6% (n=1)
perforation from the stent
Laparoscopic stoma creation group
paralytic ileus
20% (n=2)
surgical site infection
stoma ischemia
10% (n=1)
stoma prolapse

14. Conclusion
Laparoscopic stoma creation for obstructed colorectal cancer may be minimally invasive valuable alternative to SEMS.

15. References
Annual Report Prepared by the Staff of the Tumor Registry: annual report. King Faisal Specialist Hospital and Research Center.
Deans GT, Krukowski ZH, Irwin ST: Malignant obstruction of the left colon. Br J Surg 1994, 81:
Smothers L, Hynan L, Fleming J, Turnage R, Simmang C, Anthony T: Emergency surgery for colon carcinoma. Dis Colon Rectum 2003, 46:24-30.

16. Thanks